CNS sarcoidosis: evaluation with contrast-enhanced MR imaging

Reports of findings on unenhanced MR images and contrast-enhanced CT scans in patients with intracranial sarcoidosis have suggested that MR imaging without contrast enhancement may miss meningeal involvement, which is a frequent and prominent finding in neurosarcoidosis. We studied 14 patients with CNS sarcoidosis with T1- and T2-weighted pre- and postcontrast sequences and T1-weighted postcontrast sequences. Eight of 12 patients with intracranial sarcoidosis and one of two with spinal sarcoidosis had meningeal involvement that was not apparent on the unenhanced scans. Eight of 12 patients had intraaxial areas of high signal intensity on T2-weighted images, although only two of these lesions enhanced. Three patients had enhancing extraaxial masses mimicking meningiomas on postcontrast T1-weighted images. In two patients, the lesions decreased markedly in size after steroid treatment. In one patient with sarcoidosis of the optic nerve, the lesion decreased in size and the patient's vision returned to normal after Cytoxan therapy. In five of 14 patients, CNS findings were the initial clinical manifestation of the disease. In nine of 14 patients, the diagnosis of neurosarcoidosis was suggested only after administration of contrast agent. Use of gadopentetate dimeglumine greatly enhances the sensitivity of MR imaging in the detection of CNS sarcoidosis.